This application proposes to develop and test behavioral and pharmacologic techniques to reduce the prevalence and severity of cigarette smoking among patients with Chronic Obstructive Pulmonary Disease (COPD). This disease results from chronic, heavy cigarette smoking in certain biologically vulnerable individuals, and many patients with COPD continue smoking heavily despite severe, detrimental health effects. In a series of small studies, each involving 30-40 COPD patients in a VA Hospital, we will develop techniques to reinforce patients for reductions in carbon monoxide (CO) concentrations; breath CO is an excellent assessment of recent cigarette smoke inhalation. We also will measure saliva thiocyanate as a separate biological measure of smoke inhalation, and we will record patients' self-reports of current cigarette smoking. The first proposed project simply assesses CO elimination among patients with varying severity of COPD; information on persistence of CO in these patients will assist in planning the timing of CO monitoring in subsequent studies. The second study examines the efficacy of state lottery tickets to shape reduced CO concentrations in smoking COPD patients. In this project we will monitor patients' CO daily, systematically reinforcing half of the patients with state lottery tickets for CO reductions, while the other subjects receive lottery tickets on a non-contingent basis. The third project, building upon the first two, examines the frequency of monitoring visits which is required to sustain smoking reductions; two groups of patients both will be reinforced with lottery tickets for CO reductions, but one experiences daily monitoring while the other undergoes monitoring with diminishing frequency. The fourth project utilizes the most efficacious design (considering reinforcement magnitude and monitoring frequency) derived from the earlier projects, in both of two groups of patients, one of which additionally receives nicotine gum while the other receives placebo gum, administered in a double-blind, non-crossover design. This project is to determine whether nicotine gum enhances outcome in a carefully-designed behavioral program for non-motivated COPD patients. The ultimate goal of the research is to reduce the toll of illness and death from COPD produced by cigarettes.